Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

346tons in 1962 and to 155 tons in 1969. The United States consumesabout 16 percent of world production. May I add parenthetically, Mr.Chairman, that it requires about 10 units of opium to produce one unitof codeine.It seems that there are safe and effective substitutes and syntheticequivalents for morphine, which is a severe painkiller. Indeed, someare reported to be superior for use in man. But it is equally apparentthat worldwide, the medical preference for drugs derived from opiumremains strong; that is, the annual increases in production and consumptionare indicative. Proposals to ban opium production, worldwide,have not met with support and there is no evidence that eventhe American medical community would accept such a move withoutextensive consultations.Nonetheless, we feel that advocacy of such a ban is a proper position.We shall also continue to work for increased international controls,particularly to control production, until complete abolition becomesa reality.Mr. Chairman, you asked also for my views regarding methadonemaintenance procedures and whether there is a black market inmethadone.In recognition of the acceptance of methadone on an investigationalbasis in the treatment of heroin addiction the Food and Drug Administrationand the Bureau of Narcotics and Dangerous Drugsjointly issued methadone maintenance regulations effective April 2,1971.The regulations provide for advance approval of such programsby the two agencies with a maximum amount of flexibility. The standardswere agreed upon after an intensive study of many existing programsand after consultation with leading scientific authorities aroundthe country. The regulations, if faithfully followed, insure that patientsreceive adequate treatment and protection, that scientificallyuseful data can be generated and that possibilities of di^-ersion of thedrug into illicit channels are minimized.Each methadone program is also required to register with BNDDin order to conduct research with a schedule II substance. Our inspectionalprogram will cover all methadone clinics on a periodic basis toinsure that proper safeguards are maintained to prevent diversion.Safeguard requriments will be that methadone supplies be securelylocked up with limited access ; that a complete and accurate record bemaintained of all methadone receipts and dispositions ; and that patientsbe regularly monitored through urinalysis and observation toinsure that they are taking the methadone dispensed to them.I am confident that with diligent regulatory efforts by both FDAand BNDD we can effectively curtail the existing diversion problems.Where flagrant violators are uncovered, we intend to vigorously pressfor corrective measures.Failure to conduct such programs within a framework of propercontrols involves hazards to the individual and to society. Great cautionneeds to be exercised in the selection of patients for treatment becauseparticipation entails a high IcacI of narcotic dependence whichmany young persons, who are only peripherally involved in the abuseof narcotic di'iigs, could avoid by less radical forms of treatment. Wemust be sure that programs of treatment are not causing more cases